既往对一线治疗有反应的转移性乳腺癌患者对二线化疗的反应：预后因素

Response to second-line chemotherapy in patients with metastatic breast carcinoma previously responsive to first-line treatment: prognostic factors.

作者信息

Brun B, Benchalal M, Lebas C, Piedbois P, Lin M, Lebourgeois J P

机构信息

Cancer Department, University Hospital Pitie Salpetriere, Paris, France.

出版信息

Cancer. 1997 Jun 1;79(11):2137-46.

PMID:9179060

Abstract

BACKGROUND

The aim of this retrospective study was to determine those prognostic factors associated with response to a second-line chemotherapy in patients with metastatic breast carcinoma (MBC) that was previously responsive to a first-line chemotherapy.

METHODS

The 70 MBC patients studied had previously responded to a first-line chemotherapy, mainly anthracycline or anthracenedione-containing regimens. During first-line chemotherapy they had received treatment until the maximum response was obtained, at which time treatment was discontinued. Second-line chemotherapy regimens were of several types (48.5% with anthracycline). A study of prognostic factors associated with response to second-line chemotherapy was performed by univariate and multivariate analysis.

RESULTS

Second-line chemotherapy achieved a 44% response rate, with a median response duration of 10 months. Survival was 13 months in the entire patient group, 22 months in responders, and 8 months in nonresponders. Univariate analysis identified seven factors related to patient response rate to second-line treatment. A better response rate to second-line chemotherapy was observed in patients with the following features: 1) chemotherapy free time (time between onset of metastatic disease and initiation of first-line) < 12 months (P = 0.03); 2) complete response to first-line chemotherapy (P = 0.013); 3) response duration to first-line chemotherapy > 14 months (P = 0.0001); 4) progression free interval (time between end of first-line treatment and initiation of second-line chemotherapy) > 11 months (P = 0.0001); 5) performance status at second-line treatment < 2 (P = 0.04); 6) tumor index at second-line chemotherapy < 4 (P = 0.05); and 7) treatment with an anthracycline-containing second-line regimen (P = 0.03). In multivariate analysis, only progression free interval was identified as being associated with response rate to second-line chemotherapy (P = 0.0001).

CONCLUSIONS

Retained chemosensitivity appeared to be an important characteristic in patients responding to second-line chemotherapy.

摘要

背景

这项回顾性研究的目的是确定那些与转移性乳腺癌（MBC）患者二线化疗反应相关的预后因素，这些患者先前对一线化疗有反应。

方法

所研究的70例MBC患者先前对一线化疗有反应，主要是含蒽环类或蒽二酮类的方案。在一线化疗期间，他们接受治疗直至获得最大反应，此时停止治疗。二线化疗方案有几种类型（48.5%含蒽环类）。通过单因素和多因素分析对与二线化疗反应相关的预后因素进行了研究。

结果

二线化疗的缓解率为44%，中位缓解持续时间为10个月。整个患者组的生存期为13个月，缓解者为22个月，未缓解者为8个月。单因素分析确定了七个与患者二线治疗缓解率相关的因素。具有以下特征的患者对二线化疗的缓解率更高：1）化疗无间期（转移性疾病发作至一线化疗开始的时间）<12个月（P = 0.03）；2）对一线化疗完全缓解（P = 0.013）；3）一线化疗的缓解持续时间>14个月（P = 0.0001）；4）无进展间期（一线治疗结束至二线化疗开始的时间）>11个月（P = 0.0001）；5）二线治疗时的体能状态<2（P = 0.04）；6）二线化疗时的肿瘤指数<4（P = 0.05）；7）采用含蒽环类的二线方案治疗（P = 0.03）。在多因素分析中，仅无进展间期被确定与二线化疗的缓解率相关（P = 0.0001）。